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Change Order No 1-Project Completion - Fire Station No 9 Demolitions Proj No 117-088 - R&R Excavating Inc
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Change Order No 1-Project Completion - Fire Station No 9 Demolitions Proj No 117-088 - R&R Excavating Inc
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4/2/2025 1:25:05 PM
Creation date
2/14/2018 1:41:35 PM
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Board of Public Works
Document Type
Projects
Document Date
2/13/2018
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Final Waiver of Lien <br />State ofhAana,Countyof St. Joseph SS, <br />Frank Wruble being du]yMom that he/she is the Pro-�ect Manager <br />(Name of Officer) (Title) <br />Of R&R Excavating, Inc. having 00-Uttactedwith <br />(Contractor) <br />City of South Bend, Indiana <br />(Owner) <br />to furnishcertgift.mmterlaisandlorlaborAsfollows. Demolition of 5 houses & site restoration per specs <br />(Description) <br />for aprojeetknownas Fire Station #9 Demolitions; Project No. 117-088 <br />(battle of Project) <br />located at Mishawaka.Avenue & 21st Streets, South Bend, Indiana <br />andowmdby City of South Bend, Indiana <br />(Ovmer) <br />and does hereby fuMor state on the behalf ofthe aforementioned subcontractor/supplier: <br />(PARTJAL WAMR) that there is dlle. from tiro Contractor the sum of <br />Dollars ) <br />( receipt of which is hereby aokaowledged; or <br />D the payment of which has bean promised as the sole consideration for this Affidavit and Filial Waiver of Lien,wbich is given <br />solely with respect to said Amount; and which waiver shall be effective only upon receipt ofpayment thereof by the <br />undmilgned; <br />(FINAL WAIVER) thatthe final balance due from the eor&aetor is the sum of <br />Ninety—six Thousand Five HundreslDollars 96,500.90 <br />[j receipt of'whieh is hereby aftowledged; or <br />the payment of which. has been promised as the snlc consideration for this Affidavit wid i~inal Walvor of Lien which shall <br />became effective onlylipureceipt of such payment. <br />TMUFORA the unduslgnod walves and roleases unto the OW-uor ofsaid premises, any and all liens or claims whatsoever <br />on the above-describedproputy and improvoments thereon an account of labor' or material or boat, fllrnishud b the undersigned <br />tltaratn, subject to RuWatiow or conditions expressed herelul If any; and further certified thatzio other party has any claim or rfghtto a <br />lien on accauut of any workperformed or material ftished. to file u ndanigued for said reject; and wlthlu the scope of this Affidavit <br />and Waiver ofLlm <br />R&R Excavating, Inca . ' BY Q ✓ <br />(P�) (Autha tedRepresentative) <br />STATiiOFINDMA ) Frank Wruble, Project Manager <br />SS, <br />ST. JOSEP.H COUNIT } <br />Deforeme, the undersigned, a Notary public, in acid for said County and Stata, personally appeared Frank Wruble <br />and aelmowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WURLOF, Ihave, hereunto subscribed my name and affixed my official seal on the 2nd day of <br />February 2018 <br />lt-t�Publle SlgnattlYe <br />My CommissionExpiros- 9 /28/ 2024 i <br />Rebecca S. Blackston i <br />Rosidinght St. Joseph County, Indiana NotaWyPubliaNamme <br />Fo.c <br />gEGCA S. [3LA fKSTQNary Public, State of Indiana <br />St.JosophCountyMy Commission Expires <br />GjJY( fl1t7BF?g 2024 <br />
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